Temporary tubes and a system for placing same in a patient

ABSTRACT

A temporary tube for placement within a patient includes a tube having a distal end portion for placement within a patient and a proximal end portion, and a lumen increasing in cross section along at least a portion of the distal end portion toward a distal end. The lumen may increase in cross section to the distal end, along an entirety of the distal end portion, from the proximal end portion to the distal end, or along an entirety of the tube. An outer cross section of the tube is uniform along at least a portion of the proximal end portion of the tube, or the outer cross section of the tube may be uniform from a proximal end of the tube along at least a portion of the proximal end portion of the tube. The tube may include at least one vent positioned in the distal end portion.

This application is a continuation of international patent applicationnumber PCT/US16/41153 filed on Jul. 6, 2016, which in turn claimspriority from U.S. Provisional Patent Application No. 62/189,021, filedJul. 6, 2015, the disclosure of which is incorporated herein byreference.

FIELD OF THE INVENTION

This document relates generally to temporary tube placement, and morespecifically with tapered temporary tubes and related systems andmethods of placement in a patient.

BACKGROUND OF THE INVENTION

In the course of healthcare, temporary tubes such as enteral andendotracheal tubes are placed into the gastrointestinal tract or therespiratory tract, respectively, of patients for the delivery ofnutrition or suction of the gastrointestinal tract and air to therespiratory tract.

Most commonly, these tubes are placed via the nose or mouth withoutguidance and therefore tube position must be confirmed radiographicallyafter placement. While this method is simple and generally effective,the consequences of a misplaced tube can be significant. If food orliquid are delivered into the respiratory tract or if oxygen isdelivered into the gastrointestinal tract rather than the respiratorytract, for example, the consequences can be fatal.

Although several methods of tube guidance have been developed, each hascertain limitations. X-ray fluoroscopy, for example, is the dominantmethod for guided tube placement. Fluoroscopic guidance tracks the tubeprogress via its x-ray shadow. With knowledge of radiographic anatomy,the user can confirm that the tube has followed the correct path to adesired location. While effective, this method requires x-ray exposureto the patient and clinician, and requires additional equipment and apractitioner trained in the process all of which results in asignificant cost. Even more, bedside placement of a tube is usually notpossible with this method due to the size of the fluoroscopic equipment.

Another method of tube placement involves positional tracking on asystem utilizing a simulated display. As described in US PublishedPatent Application No. 2013/0218006, the system monitors a position of atip of the tube and provides a graphic representation of a path of thetip on a display. In other words, the system provides a graphicrepresentation of the path of the tip, thereby allowing a skilled userto monitor the progress of the tip during placement. While this methodmay be utilized at the patient's bedside, it does not provide aconfirmation with respect to the individual patient's anatomy and wouldnot indicate if the tube had perforated through the wall of thegastrointestinal tract. The limitations of these methods underscore theneed for a method which provides direct visualization for tubeplacement.

Along these lines, numerous visualization systems for endotracheal tubeplacement have been developed. A majority of these systems place a videocamera or other visualization means on a laryngoscope. The laryngoscopeprovides retraction of the tongue and glottis thereby establishing andvisualizing a pathway to the vocal cords, through which the endotrachealtube must pass to enter the trachea. Other of these systems utilize avideo camera positioned within an end of the enteral tube. These systemsutilize battery powered light emitting diodes (LEDs) positioned near thecamera within the tip of the tube for illuminating the pathway of thetube.

Despite the advancement of a more direct method of visualization for theclinician, current video camera systems suffer from certain limitationsassociated with utilization of the camera. Specifically, the camera lenscan become cloudy or obstructed by fluids and/or food debris duringutilization thereby hindering the clinician's ability to visualize thepathway. Even more, the amount of light generated by the LEDs isinsufficient to accommodate visualization primarily due to size and heatgeneration limitations. Accordingly, a need exists for a temporary tubeplacement system which provides a direct method of visualization. Thesystem should provide a sufficient amount of light within the pathwaywithout excessive heat and a means of cleaning fluid and/or food debrisfrom the camera lens, as required, to ensure proper visualization forthe clinician during placement of the tube.

Even enteral tubes properly placed by any of the above-describedmethods, however, suffer from drawbacks associated with their tendencyto clog. Frequently, medications in pill form must be crushed anddelivered down the enteral tube placed in the stomach or small bowel.These pill fragments have a tendency to clog tubes. Tube feedingsolution is similarly prone to congealing and creating clogs. If clogsoccur and are unable to be cleared, the tube must be withdrawn from thepatient and replaced at added expense, and discomfort and risk to thepatient. Accordingly, any tube placement system should further minimizethe potential for clogging and also allow for easier clog removal in theevent a clog occurs.

SUMMARY OF THE INVENTION

In accordance with the purposes and benefits described herein, atemporary tube, systems for placement of temporary tubes, and relatedmethods are of tube placement are provided. The temporary tube may bebroadly described as including a tube having a distal end portion forplacement within a patient and a proximal end portion. The tube has alumen increasing in cross section from the proximal end portion towardthe distal end portion along at least a portion of the tube.

In one possible embodiment, the cross section is an inner diameter ofthe tube. In another, the tube includes at least one vent positioned inthe distal end portion.

In another possible embodiment, the tube includes a tip attached to thedistal end portion of the tube and the tip includes at least one vent.In yet another, the tip includes at least one wall adjacent a distal endof the tip for deflecting matter discharged from the at least one vent.

In still another possible embodiment, the lumen cross section is amaximum size at a distal end of the distal end portion. In anotherpossible embodiment, the tube has an outer cross section increasing insize between the proximal end portion and the distal end portion. In yetanother, the lumen cross section is a maximum size at the at least onevent. In yet another possible embodiment, the lumen cross sectionincreases in size from the proximal end portion to the distal endportion of the tube.

In one other possible embodiment, the tube further includes a stylet forsteering the tube during insertion. In another, the stylet is a nitinolwire for bending the distal end portion of the tube when a voltage isapplied to the nitinol wire.

In one other possible embodiment, a temporary tube for placement withina patient includes a tube having a distal end portion and a proximal endportion, the tube having a lumen extending a length of the tube, acamera having an aperture and a lens, the camera positioned adjacent thedistal end portion of the tube for positioning the tube during placementin the patient; and a light source providing light at a distal end ofthe tube.

In another possible embodiment, the tube lumen increases in crosssection from the proximal end portion toward the distal end portionalong at least a portion of the tube. In still another, the lumen crosssection is a maximum size at the distal end. In yet another, the lumencross section increases in size from the proximal end portion to thedistal end of the tube.

In yet still another possible embodiment, the light source includes atleast one light emitting diode. In another possible embodiment, the atleast one light emitting diode is supported adjacent the camera.

In another possible embodiment, the system for placing a temporary tubein a patient further includes at least one fiber optic element extendingalong the tube, the at least one fiber optic element positioned adjacentthe at least one light emitting diode at the proximal end of the tubeand adjacent the tip at the distal end of the tube for guiding lightfrom the at least one light emitting diode.

In still another possible embodiment, the tip includes at least onechannel for directing a fluid onto the lens of the camera. In another,the system further includes an enclosure attached to the tube. In yetanother, the enclosure includes a slide for retracting the at least onefiber optic filament and the camera from the tube. In one other possibleembodiment, the enclosure includes a fitting for receiving irrigationfluid and in another the enclosure includes a video output cable.

In one other possible embodiment, the tip includes at least one channelfor directing a fluid onto the lens. In another, the tube includes atleast one vent positioned in the distal end portion of the tube and theat least one fiber optic filament occludes the at least one ventdirecting the fluid through the at least one channel.

In still another possible embodiment, the tip further includes at leastone slot through which light guided through the at least one fiber opticelement exits.

In one other possible embodiment, a temporary tube includes a tubehaving a proximal end and a distal end, a stylet for steering the tubeduring insertion, a camera having an aperture and a lens, the cameraattached to the stylet, and a light source positioned adjacent thedistal end of the tube.

In still another possible embodiment, the tube further includes a styletfor steering the tube during insertion. In another, the enteral tubefurther includes a power source, and the stylet is a nitinol wire forbending the distal end portion of the tube when a voltage from the powersource is applied to the nitinol wire.

In still one other possible embodiment, a temporary tube placementsystem includes a tube having a proximal end and a distal end, a camerasupported by the tube at the distal end, a plurality of fiber opticfilaments through which light from a light source travels from theproximal end to the distal end, a screen for displaying images from thecamera, and a power source electrically attached to the camera and thelight source.

In another possible embodiment, the screen is a smart phone screen. Instill another possible embodiment, the enteral tube placement systemfurther includes a recording device for recording the images from thecamera.

In accordance with another aspect, a method of placing a temporary tubein a patient is provided. The method may be broadly described ascomprising the steps of: (a) inserting an end of a tube having a lumenincreasing in cross section from a proximal end portion toward a distalend portion along at least a portion of the tube into the patient; (b)positioning a camera and a plurality of fiber optic filaments within alumen of the tube; (c) monitoring a display to determine a position ofthe end of the tube; and (d) guiding the end of the tube utilizing astylet until a desired position for the end of the tube is achieved.

In one other possible embodiment, the method further includes the stepof placing an irrigation fluid into the tube when a lens of the camerabecomes obscured by mucous or other material in the gastrointestinaltract. In still another, the method further includes the steps ofwithdrawing the plurality of fiber optic filaments and the stylet to aposition proximal to the camera, and removing the plurality of fiberoptic filaments, the stylet, and the camera from a proximal end of thetube.

In the following description, there are shown and described severalpreferred embodiments of temporary tubes and systems for placing same.As it should be realized, the tubes and placement systems are capable ofother, different embodiments and their several details are capable ofmodification in various, obvious aspects all without departing from thetubes and systems as set forth and described in the following claims.Accordingly, the drawings and descriptions should be regarded asillustrative in nature and not as restrictive.

BRIEF DESCRIPTION OF THE DRAWING FIGURES

The accompanying drawing figures incorporated herein and forming a partof the specification, illustrate several aspects of the invention andmethod and together with the description serve to explain certainprinciples thereof. In the drawing figures:

FIG. 1 is a perspective view of a tube placement system including acontrol enclosure;

FIG. 2 is an enlarged perspective view of a distal end portion of thetube and camera;

FIG. 3 is an enlarged perspective view of the distal end portion showingthe camera and an alternate LED light source configuration;

FIG. 4 is a perspective view of an alternate tube placement systemwherein the camera and light source are fixed at a distal end portion ofthe tube;

FIG. 5a is a partial plan view of a tube having a gradually increasinglumen cross section in a portion positioned within a patient;

FIG. 5b is a partial plan view of a tube having a gradually increasinglumen cross section and a uniform outer cross section;

FIG. 6 is a cross section of a perspective view of a tip supported bythe tube for supporting the camera and fiber optic filaments;

FIG. 7 is a perspective view of the tip supported by the tube showingthe camera cable and fiber optic filaments extending beyond a portion ofthe tube;

FIG. 8 is a schematic diagram of the tube placement system;

FIG. 9 is an alternate embodiment of an enclosure combining a steeringmechanism for guiding the tube into the patient; and

FIG. 10 is an alternate embodiment of a temporary tube having a tipattached at a distal end thereof.

Reference will now be made in detail to the present describedembodiments of the invention and related method, examples of which areillustrated in the accompanying drawing figures, wherein like numeralsare used to represent like elements.

DETAILED DESCRIPTION

Reference is now made to FIG. 1 which partially illustrates a system 10for placing an enteral tube in a patient (P). Enteral tubes include, butare not limited to, nasogastric tubes, nasoduodenal tubes, oral gastrictubes, oral duodenal tube, and feeding tubes located distal to theduodenum. Alternatively, the system 10 may be utilized to placeendotracheal tubes which are designed to reside in the patient's tracheaand enter the body through the mouth or the nose.

In the described embodiment, the system 10 includes a tube 12 having aproximal end portion 14 and a distal end portion 16 for placement withinthe patient. A video camera 18 positioned within a housing 20 is locatedat the distal end portion 16 of tube 12. The camera 18 includes anaperture 22 covered by a lens 24, as is known in the art, and a cable 26is connected to the camera 18 and extends through a rear wall 28 of thehousing 20. In an alternate embodiment, the cable 26 may include aconnector at its distal end for connection to a mating connector mountedon the rear wall 28 of the camera housing 20. Either way, the cable 26extends along the tube 12 providing a signal external to the patient (P)and power to the camera 18 as will be described in more detail below.

In the described embodiment, the camera 18 is positioned in a lumen 30of the tube 12 and is removable after placement within the patient (P).The camera 18 may be a single use disposable camera or a multiple usecamera suitable for cleaning and/or sterilization. Alternatively, thecamera 18 may be contained in a disposable sheath (not shown) having anoptically clear end positioned adjacent the camera lens 24. Afterplacement of the tube 12 and removal of the camera 18, the sheath wouldbe discarded and a new sheath utilized in a subsequent use of the camera18.

As further shown in FIG. 1, a plurality of fiber optic filaments 32extend within the lumen 30 generally adjacent an interior wall of thetube 12 and guide light from an external light source onto an area ofthe gastrointestinal or GI tract adjacent the camera 18. In thedescribed embodiment, the external light source is a plurality of highintensity light emitting diodes or LEDs which may be positioned adjacentends of the fiber optic filaments 32 utilizing heat shrink sleeves orotherwise as is known in the art.

Of course, other light sources may be utilized in alternate embodimentsas shown in FIG. 2, for example. In this embodiment, miniature LEDs 34are positioned near a camera 36 to provide illumination of the patient'sGI tract during insertion of a tube 38. The camera 36 is containedwithin a watertight housing 40 and a lens 42 covers camera aperture 44as well as the LEDs 34. While suitable in most instances, the intensityof the illumination provided in this alternate embodiment may beimproved upon.

One way to increase the intensity of the illumination is to utilizelarger, high intensity LEDs 46. In the described embodiment whereinfiber optic filaments 32 are utilized to guide light from the LEDs 46positioned outside of the patient and into the patient's GI tract, thelarger LEDs (e.g., high intensity LEDs) may be utilized. This is due toa lack of size limitation created by placement within the tube 12 andless concern with heat generated thereby because the LEDs 46 arepositioned outside of the patient (P).

As shown in FIG. 3, the camera 36 utilized in the alternate embodimentis located at a distal end portion 48 and is preferably contained withinor contiguous with an outer cross section of the tube 38. In thisembodiment, the camera 36 remains with the tube 38 for its duration ofuse. The camera 36 and LEDs 34 may be integrally molded and containedwithin an outer wall of the tube providing a smooth surface along theentire exterior of the tube. A multiplicity of vents 52 are locatedwithin the tube 38 along its distal end portion 48, but proximal to thecamera 36 to discharge matter into the patient.

In the alternate embodiment, the tube wall 50 consists of a double layerof flexible material having a wire harness 54 positioned between thelayers and apart from from the working lumen used for the therapeuticpurpose of the tube 38 such as feeding or suction. In other alternateembodiments, the tube wall 50 may be a single layer with a separatechannel for harness 54 to keep it isolated from the liquid materialspassing through the working lumen of the tube 38.

As shown in FIG. 4, industry standard connectors (not shown) may belocated at a proximal end portion 56 of the tube 38. An electricalconnector 58 may be located separate from the tube 38 or attached at theproximal end portion 56 adjacent proximal end 60. The wiring harness 54runs from the camera 36 and LEDs 34 to the proximal end portion 56 ofthe tube 38 where the connector 58 is located. A power supply and signalprocessing electronics for operation of the camera 36 and LEDs 34 may belocated external to the tube 38 and are attached on a temporary basis asneeded, such as during insertion. In addition, a flexible, steerablestylet 62 may be used via placement within the lumen of the tube 38 atthe proximal end 60, and is also not shown in this figure.

In the embodiment shown in FIG. 1, the camera cable 26 and a stylet 86extend centrally within the plurality of fiber optic filaments 32. Thestylet 86 is provided to stiffen and guide the tube 12 during initialinsertion. In the described embodiment, a nitinol wire (aka “a memorywire”) is used to create a deflection at the distal end portion 16 ofthe tube 12. Using the video images provides by the camera 18, steeringonly requires a tip 74 of the tube 12 to bend in one direction since thetube can be rotated.

The nitinol material has the physical property of existing in one shapeunder normal circumstances, but will transform to a differentconfiguration when an electrical voltage or current is applied thereto.For this application, the nitinol stylet would have a straightconfiguration as its norm or baseline. If the clinician desires thedistal end portion 16 of the tube 12 to turn, an electricalcurrent/voltage from a power supply 90 is applied to the nitinol wireand an end of the nitinol wire will take on its alternate or memoryconfiguration of a bend. To do so, the clinician activates a switch orpotentiometer (not shown) to send a current/voltage to the nitinolstylet 86 creating the variable deflection of the distal end portion 16.

In one alternate embodiment, two nitinol wires may be utilized withmemory bends in differing directions to provide alternative steeringoptions. In another alternate embodiment, the fiber optic filaments 32may be used to generate deflection of the distal end portion 16 of thetube 12 for steering.

In addition to the nitinol stylet 86 described, steering of the tube 12may alternatively be provided by a two component stylet in which onewire remains stationary and the other moves linearly against the firstwire. The stationary and moving wires are rigidly attached only at theirproximal ends. An outer sheath or a series of connectors binds the twocomponents together while allowing linear slide of the moving component.Thus, a deflection is created at the proximal end portion 14 of the tube12 as the moving wire is advanced or withdrawn relative to thestationary wire.

In another alternate embodiment, the camera 36 and LEDs 34 may beattached to a proximal end of the stylet 62 rather than the tube 38.Thus, the camera 36 and LEDs 34 can be withdrawn through the lumen ofthe tube or external to the lumen after placement. In this alternateembodiment, a cable for video signals as well as power would runparallel or within the stylet 62. The cable and stylet 62 may further becontained within a sheath which also includes or integrates with thecamera 36. A connector may be located on a proximal end of the stylet.

As best shown in FIG. 5a , the tube 12 in the initial describedembodiment has a tapered configuration. In other words, a portion 62 ofthe tube 12 which will reside within the patient (P) will have agradually increasing lumen cross section 64 from a proximal end 66 to adistal end 68. The portion 70 of the tube 12 which remains external tothe patient (P) may have a uniform lumen cross section 72 or, in analternate embodiment, a tapered lumen cross section 73 may extend alongthe entirety of the tube 12, as shown in FIG. 5b , or along a portionthereof. For example, the lumen cross section may gradually increasefrom a proximal end portion of tube 12 toward a distal end or a distalend portion of the tube 12. Even more, an outer cross section of thetube may be uniform, as shown in FIG. 5b , or may gradually increase inareas where the lumen cross section gradually increases as shown in FIG.5a . If the tube 12 is round, the lumen cross section will necessarilybe an inner diameter of the tube.

The purpose of providing a gradually increasing lumen cross section isto provide a smaller cross section at the area which would be best forpatient comfort, such as the portion of the tube 12 residing in thenose. Then, distal to this, having the gradual increase in cross sectionmakes clogging less likely. When the tube 12 is in place, the patient(P) will not be able to detect the larger cross section of the tube 12distally.

Further, should a clog develop in the tapered portion 62 of the tube 12within the patient (P), gentle pressure with a suitable fluid flush willmake clearing the clog more likely than with a uniform lumen crosssection. To further diminish the risk of clogging, an interior surfaceof the tube 12 may be coated in a non-stick or lubricious material.Clogs located in the constant lumen cross section portion 70 of the tube12 would be mostly external to the patient (P). In this portion 70,external pressure may also be applied by the clinician to the tube 12 tomilk or break up the clog and enhance clearing along with fluid flush.

As shown in FIG. 6, the described system 10 for placing an enteral tubein a patient (P) further includes a tip 74 (shown in cross-section forclarity) supported at the distal end portion 16 of tube 12. The tip 74includes a flange 76 received within the lumen 30 of the tube 12 forsecuring the tip within the tube. The camera 18 is positioned within thetip 74 and the camera cable 26 extends from the camera along the tube12. In addition, the plurality of fiber optic filaments 32 extend withinthe tube 12 and terminate adjacent a distal end 78 of the tip 74. A slotor aperture 80 allows light guided through the fiber optic filaments 32from the LEDs 46 to exit the tip 74 and illuminate the area around thetip within the patient (P).

As further shown, irrigation channels 82 are formed in the tip 74. Ifthe camera lens 24 becomes obscured by mucous or other material in thegastrointestinal tract, a fluid is placed into the tube 12 and directedacross the camera lens 24 via the irrigation channels 82. Further, ifthe development of an optical cavity is needed, air may be insufflatedthrough the irrigation channels 82 using an irrigation fitting toenhance visualization.

As shown in FIG. 7, a vent 84 is formed in the distal end portion 16 ofthe tube 12 to discharge matter into the patient (P). Although only onevent 84 is shown, a second vent is positioned opposite the vent 84 inthe described embodiment and additional vents may be utilized inalternate embodiments if desired. As shown, the vent 84 is occluded bythe fiber optic filaments 32 which is the norm during insertion of thetube 12. In this arrangement, the fiber optic filaments 32 prevent fluidplaced into the tube to clean the camera lens 24 from escaping the tubeinto the patient prior to entering the irrigation channels 82 and ontothe camera lens. In an alternate embodiment, a separate flap or portionof the camera or disposable camera sheath may serve to direct irrigationfluid flow across the lens, rather than the fiber opticfilaments/irrigation channels.

When the tube 12 has been successfully navigated into position withinthe patient (P), the camera 18, fiber optic filaments 32, and stylet 86are retracted from the tube leaving the tube and the tip 74 in placewithin the patient. This process is described in additional detailbelow, however, retraction of the fiber optic filaments 32 opens thevent 84 and allows for medicines, fluids, food, or the like to exit thetube 12 into the patient (P).

In the described embodiment of the system 10, the camera 18, fiber opticfilaments 32, and a stylet 86 all terminate proximally in an enclosure88. As shown schematically in FIG. 9, the enclosure 88 contains a powersource 90, a video display 94, and a processor 96 for processing thesignals from the camera. In an alternate embodiment, at least portionsof the signal processing electronics (e.g., a processor) may be locatedadjacent to the camera 18 in the distal end portion 16 of the tube 12.

The enclosure 88 further includes a releasable fitting or collet 98which grips the tube 12 ensuring that the camera 18, fiber opticfilaments 32, and stylet 86 remain in position during placement. Inaddition, a fitting 99, for example a Luer lock fitting, is mounted tothe enclosure 88 to attach a syringe or pump for irrigation of the tube.

Due to the tapered design of the tube 12, the proximal end portion 14through which the camera 18, fiber optic filaments 32, and stylet 86must pass has a smaller lumen cross section than the distal end portion16. Thus, the sequenced or staged removal of the camera 18, fiber opticfilaments 32, and stylet 86, as shown in FIG. 1, is required in order toallow the camera to pass through the proximal end portion 14 of the tube12.

Accordingly, the stylet 86 and fiber optic filaments 32 must be removedbefore the camera 18 which has a larger diameter than the cable 26 towhich it is attached. More specifically, the fiber optic filaments 32and stylet 86 are withdrawn partially or completely first so that theymay pass through the proximal end portion 14 of the tube 12 alongside ofthe camera cable 26 only. Then, the larger camera housing 20 whichoccupies nearly the entire lumen cross section of the tube 12 iswithdrawn.

The staged removal of these components is accommodated by the enclosure88. In the described embodiment, the clinician moves an enclosuremounted slide 100 which partially withdraws the fiber optic filaments 32and stylet 86 so that their distal portions are now proximal to thecamera 18. Simultaneously, the fitting 98 gripping the proximal endportion 14 of the tube 12 is released. The clinician holds the proximalend portion 14 of the tube 12 while the camera 18, fiber optic filaments32, and stylet 86 are withdrawn from the tube by pulling the enclosure88. The clinician then attaches an industry standard connector forfeeding or suction systems, such as the ENFit connector, to the proximalend of the tube 12. In other embodiments wherein the lumen cross sectionis constant throughout the tube, withdrawal of the noted items may occursimultaneously.

In the described embodiment, the display 94 is attached to the enclosure88 and processor 96 via a video output cable 102 for displaying imagesfrom the camera 18. In an alternate embodiment, the display or screenmay be remotely positioned including, for example, on a handheldcomputing device, a smart phone, or other remote display that receivesinformation from the processor via WIFI, Bluetooth, or other transmitand receive mechanisms. Even more, a recording device for recording theimages from the camera may be used.

In an alternate embodiment shown in FIG. 9, a steering controller 92 maybe utilized to guide the tube 12 into the patient (P) via the stylet 86which is provided to stiffen and guide the tube 12 for initialinsertion. As shown, an enclosure 104 combines the elements of theenclosure 88 with a thumb wheel 106 for changing direction of the distalend portion 16 of the tube 12 during insertion.

In operation, the clinician connects the tube 12 to the enclosure 88which provides power to the camera 18 and LED's 46 illuminating thefiber optic filaments 32. The video data from the camera 18 is displayedon the display 94. A stylet 86 is positioned in the lumen cross sectionof the tube 12 to stiffen and guide the tube during insertion.

The clinician then inserts the distal end portion 16 of the tube 12 intothe patient (P) via the nose or mouth. The camera 16, located within thedistal end portion 16 of the tube 12, provides the clinician with a viewof the path the tube is following as it is advanced. If the clinicianidentifies that the tube 12 is passing into the trachea instead of theesophagus, the clinician may withdraw the tube and re-advance. Further,steering is possible by means of the stylet 86.

The fiber optic filaments 32 provide illumination of the internal bodycavities. Thus, this process is similar to endoscopy which is performedroutinely for diagnostic and therapeutic purposes. The cliniciancontinues to advance the tube 12 until the desired destination withinthe GI tract is reached. The interior portion of each segment of the GItract has a characteristic appearance thus allowing positiveidentification of the tip 74 of the tube 12. Also, as with endoscopy, ifthe camera lens 24 becomes obscured by mucous or other material in theGI tract, irrigation is placed into the tube 12 via fitting 99 anddirected across the camera lens by the irrigation channels 82.

When the desired position of the distal end portion 16 of the tube 12has been achieved, the clinician activates the slide mechanism 100 whichpartially withdraws the fiber optic filaments 32 and stylet 86 so theirdistal portions are now proximal to the camera housing 20.Simultaneously, the fitting 98 which clamped the proximal end portion 14of the tube 12 is released. The clinician holds the proximal end portion14 of the tube 12 while the enclosure 88, camera 18, fiber opticfilaments 32, and stylet 86 are withdrawn as described in detail above.The clinician then attaches an industry standard connector to theproximal end of the tube 12.

In the event a clog occludes flow of tube feeding materials, theclinician attaches a syringe (not shown) filled with water or otherunclogging fluid to the fitting 99. Pressure generated by the syringeand fluid column will apply a forward force to the clog. This will pushthe clog distally to a portion of the tube 12 where the lumen crosssection is slightly larger. When distal movement has been achieved,friction will decrease and the clog will pass forward from that point.

In the secondary embodiment where the system 10 is utilized forplacement of an endotracheal tube, the camera 36 and LEDs 34 arepositioned proximally on the end of a semi-rigid stylet which residestemporarily within the lumen of the tube 38. Video information isdisplayed on the display located at the distal aspect of the tube 38.First, the clinician inserts the camera 36 and semi-rigid stylet intothe tube 38. In the preferred embodiment, the video display is attachedto the proximal end of the endotracheal tube 38 leaving the clinicianone hand for the laryngoscope and the other for the endotracheal tubewith attached video system. Then, the clinician inserts the tube 38 intothe patient's mouth or nose.

As noted, a laryngoscope may be utilized to provide retraction of thetongue and epiglottis thereby exposing the vocal cords. The vocal cordswould be seen on the display 94 as the tube 38 is advanced toward andultimately through them into the patient's trachea. With endotrachealintubation, precise placement is extremely important. If the tube 38 isnot advanced far enough, injury to the vocal cords or inadvertentremoval of the tube can result. If the tube 38 is advanced too far, itwill usually proceed down the right mainstem bronchus. In thissituation, the left side of the lung will not receive adequateventilation leading to lung collapse, pneumonia, oxygen deficiency orother life-threatening problems. When the tube 38 has been advanced tothe proper position as confirmed by the video image, the stylet 86 withattached camera 36 and LEDs 34 are withdrawn leaving the tube 38 inplace.

In summary, numerous benefits result from a system 10 for placing atemporary tube in a patient as illustrated in this document. The system10 provides a temporary tube placement system with a direct method ofvisualization. In addition, the system 10 provides a sufficient amountof light within the pathway without excessive heat and provides forcleaning fluids and/or food debris from the camera lens to ensure propervisualization for the clinician during placement of the tube. Even more,the system minimizes the potential for clogging and allows for easierclog removal in the event a clog occurs by utilizing tubes having lumencross section which gradually taper.

The foregoing has been presented for purposes of illustration anddescription. It is not intended to be exhaustive or to limit theembodiments to the precise form disclosed. Obvious modifications andvariations are possible in light of the above teachings. For example,temporary tube placement may be accomplished without video cameraassistance as shown in FIG. 10. In this embodiment, the tube 110 has alumen increasing in cross section from a proximal end portion 112 to adistal end portion 114 along at least a portion of the tube. A tip 116is attached to a distal end of the tube 110 and includes a pair of vents118. A wall 120 is positioned adjacent a distal end of each vent 118 fordeflecting medicines, fluids, food, or the like from the vent into thepatient (P). All such modifications and variations are within the scopeof the appended claims when interpreted in accordance with the breadthto which they are fairly, legally and equitably entitled.

What is claimed:
 1. An enteral tube for placement within a patient,comprising: a tube having a distal end portion for placement within apatient and a proximal end portion, and a lumen increasing in crosssection along at least a portion of the distal end portion toward adistal end.
 2. The enteral tube for placement within a patient of claim1, wherein the lumen increases in cross section to the distal end. 3.The enteral tube for placement within a patient of claim 1, wherein thelumen increases in cross section along an entirety of the distal endportion.
 4. The enteral tube for placement within a patient of claim 1,wherein the cross section is an inner diameter of the tube.
 5. Theenteral tube for placement within a patient of claim 1, wherein thelumen increases in cross section from the proximal end portion to thedistal end.
 6. The enteral tube for placement within a patient of claim1, wherein the lumen increases in cross section along an entirety of thetube.
 7. The enteral tube for placement within a patient of claim 1,wherein an outer cross section of the tube is uniform along at least aportion of the proximal end portion of the tube.
 8. The enteral tube forplacement within a patient of claim 1, wherein an outer cross section ofthe tube is uniform from a proximal end of the tube along at least aportion of the proximal end portion of the tube.
 9. The enteral tube forplacement within a patient of claim 1, wherein the tube includes atleast one vent positioned in the distal end portion.
 10. The enteraltube for placement within a patient of claim 1, further comprising a tipattached to the distal end portion of the tube.
 11. A temporary tube forplacement within a patient, comprising: a tube for placement within apatient having a lumen increasing in diameter along at least a portionof the tube to a distal end.
 12. The temporary tube for placement withina patient of claim 11, wherein the lumen increases in diameter along anentirety of the tube.
 13. The temporary tube for placement within apatient of claim 11, wherein an outer diameter of the tube is uniformalong at least a portion of a proximal end portion of the tube.
 14. Thetemporary tube for placement within a patient of claim 11, wherein anouter diameter of the tube is uniform from a proximal end of the tubealong the at least a portion of the proximal end portion of the tube.15. The temporary tube for placement within a patient of claim 11,wherein the tube includes at least one vent positioned in a distal endportion.
 16. An enteral tube for placement within a patient, comprising:a tube having a distal end portion for placement within a patient and aproximal end portion, and a lumen increasing in diameter along at leasta portion of the tube to a distal end.
 17. The enteral tube forplacement within a patient of claim 16, wherein the lumen increases indiameter along an entirety of the tube.
 18. The enteral tube forplacement within a patient of claim 16, wherein an outer diameter of thetube is uniform along at least a portion of the proximal end portion ofthe tube.
 19. The enteral tube for placement within a patient of claim16, wherein the lumen increases in cross section from the proximal endportion to the distal end.
 20. The enteral tube for placement within apatient of claim 16, further comprising a tip attached to the distal endof the tube.